Provider Demographics
NPI:1447612858
Name:SELL, KENNETH (LMFT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:SELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 11TH AVE NW STE 300
Mailing Address - Street 2:DEWITZ PLAZA
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2297
Mailing Address - Country:US
Mailing Address - Phone:507-292-1379
Mailing Address - Fax:507-289-4524
Practice Address - Street 1:602 11TH AVE NW STE 300
Practice Address - Street 2:DEWITZ PLAZA
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2297
Practice Address - Country:US
Practice Address - Phone:507-292-1379
Practice Address - Fax:507-289-4524
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3220101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health